Basic Information
| Provider Information | |||||||||
| NPI: | 1447412374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOMAN | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | FREDERICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 MANNING DRIVE | ||||||||
| Address2: | CAMPUS BOX 7595 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199662718 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1702 OWEN DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103233184 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2008 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0901X | 0101246577 | VA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 390200000X | 0101246577 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2083P0901X | 2019-00952 | NC | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
No ID Information.